Renal dysfunction and the associated decrease in survival after elective endovascular aneurysm repair

Abstract

Objective The reported frequency of renal dysfunction after elective endovascular aneurysm repair (EVAR) varies widely in current surgical literature. Published research establishes pre-existing end-stage renal disease as a poor prognostic indicator. We intend to quantify the mortality effect associated with renal morbidity developed postoperatively and to identify modifiable risk factors. Methods All elective EVAR patients with preoperative and postoperative renal function data captured by the Vascular Quality Initiative between January 2003 and December 2014 were examined. The primary study end point was long-term mortality. Preoperative, intraoperative, and postoperative parameters were analyzed to estimate mortality stratified by renal outcome and to describe independent risk factors associated with post-EVAR renal dysfunction. Results This study included 14,475 elective EVAR patients, of whom 96.8% developed no post-EVAR renal dysfunction, 2.9% developed acute kidney injury, and 0.4% developed a new hemodialysis requirement. Estimated 5-year survival was significantly different between groups, 77.5% vs 53.5%, respectively, for the no dysfunction and acute kidney injury groups, whereas the new hemodialysis group demonstrated 22.8% 3-year estimated survival (P < .05). New-onset postoperative congestive heart failure (odds ratio [OR], 3.50; 95% confidence interval [CI], 1.18-10.38), return to the operating room (OR, 3.26; 95% CI, 1.49-7.13), and postoperative vasopressor requirement (OR, 2.68; 95% CI, 1.40-5.12) predicted post-EVAR renal dysfunction, whereas a preoperative estimated glomerular filtration rate (eGFR) ≥60 mL/min/1.73 m2 was protective (OR, 0.33; 95% CI, 0.21-0.53). Volume of contrast material administered during elective EVAR varies 10-fold among surgeons in the Vascular Quality Initiative database, but the average volume administered to patients is statistically similar, regardless of preoperative eGFR. Multivariable logistic regression demonstrated nonsignificant correlation between contrast material volume and postoperative renal dysfunction. Conclusions Any renal dysfunction developing after elective EVAR is associated with decreased estimated long-term survival. Protecting renal function with a rational dosing metric for contrast material linked to preoperative eGFR may better guide treatment.

The ratio of contrast medium volume to estimated glomerular filtration rate as a predictor of contrast‐induced nephropathy after endovascular aortic repair

“…Developing CIN results in worse treatment outcomes related to mortality, serious morbidity, and myocardial infarction after PCI (15). Postoperative renal dysfunction after EVAR has been reported to be associated with decreased estimated long-term survival (7). Additionally, this study demonstrated that CIN immediately after EVAR was associated with more hospital deaths and worsened 1-year mortality.…”

“…It is associated with a longer hospital stay, renal impairment, and higher mortality (5,6). Zarkowsky et al (7). reported that postoperative renal dysfunction after EVAR was associated with decreased estimated long-term survival.…”

Acute Kidney Injury Following Elective Open Aortic Repair with Suprarenal Clamping

“…[2][3][4][5][6][7] Postoperative AKI is a common, but serious, complication of aortic repair for AAA because it may increase early mortality 8,9) and patients hospital stay 10,11) ; it may also affect late survival. 8,12,13) Although much attention to date has been given to this complication, research into AKI following AAA repair remains challenging due to the fact that AAAs differ from each other morphologically and clinically. For example, some aneurysms are ruptured and some unruptured, and some involve visceral vessels whereas others do not.…”

Use of Synchrotron Radiation to Accurately Assess Cross-Sectional Area Reduction of the Aortic Branch Ostia Caused by Suprarenal Stent Wires

“…5 While many studies have reported satisfactory results of this less invasive procedure, the long-term outcomes of EVAR, specifically, the effect of aortic stent wires on renal blood flow and subsequent renal function is still a main concern to clinicians when evaluating the durability of this technique. [6][7][8][9][10] AAA patients treated with EVAR have regular imaging surveillance to determine whether the aortic aneurysm is successfully excluded, the stent-graft is position properly in relation to the aortic branches, and the renovisceral arteries are patent. Computed tomography angiography (CTA) is currently the reference imaging modality for follow-up of EVAR.…”